arXiv subjects

Bailiang Jian

Publications and source records attributed to Bailiang Jian.

15 recordsLinked to original sources

arXiv2026

Model Effect or Label Effect? Refined Annotations and a Human-Referenced Benchmark for Pulmonary Embolism Segmentation

Purpose: To quantify how evaluation annotations influence measured pulmonary embolism (PE) segmentation performance relative to model training changes, and to establish a human-referenced framework. Materials and Methods: This retrospective study screened 166 voxel-annotated CT pulmonary angiography cases from CADPE (n=91), FUMPE (n=35), and READ (n=40); 149 were included. A primary rater annotated PE by protocol, and a senior thoracic radiologist reviewed and revised all segmentations. Three additional raters at three centers annotated a 15-case subset. The label effect was measured by evaluating two pretrained nnU-Net models (nnU-Net-A, nnU-Net-B) against original and refined annotations. The model effect was measured by comparing the same architecture trained on different dataset combinations with annotations fixed. The benchmark model (nnPE) was trained with leave-one-dataset-out and pooled five-fold cross-validation. Four metric categories were analyzed with case-paired Wilcoxon signed-rank tests, Benjamini-Hochberg correction, and bootstrap 95% CIs. Results: Changing only the annotation increased mean DSC by 0.143 (0.122-0.166) for nnU-Net-A and 0.188 (0.163-0.213) for nnU-Net-B (both P < .001), whereas changing training-dataset composition changed DSC by 0.028. The label effect exceeded the model effect on CADPE and FUMPE and was 0.045 on READ. Within-mask attenuation SD fell in all three datasets after re-annotation (all P < .001). nnPE reached DSC 0.72 +/- 0.22 on pooled cross-validation but scored below all four annotators across 52 paired comparisons (all corrected P < .05). Conclusion: Evaluation annotations affected measured PE segmentation performance at least as much as model training choices. A human-referenced evaluation framework is publicly available for future study.

eess.IV↗

arXiv2026

Generating Reports or Repeating Templates? Measuring and Mitigating Template Collapse in 3D CT Report Generation

Modern 3D medical vision-language models (VLMs) can generate fluent radiology-style text while exhibit critically low pathology detection and output diversity, collapsing to generic templates that under-report rare yet critical findings. We identify this failure mode as Template Collapse. This failure stems from the unique constraints of 3D medical imaging, e.g., limited data, severe label imbalance, and weak signals from volumetric encoders. Under these constraints, text-generation objectives encourage shortcut learning and fluent but weakly grounded reports. We systematically diagnose the Template Collapse through clinical fidelity, output diversity, normal-template bias, and rare-finding survival. To mitigate it, we propose CLarGen, a decoupled framework that separates what to say (clinical detection) from how to say it (language synthesis). CLarGen uses (i) a Latent Query Transformer for multi-label pathology detection, (ii) pathology-guided retrieval for clinically matched exemplars, and (iii) a medical language model to synthesize the final report from detected findings and retrieved context. Across state-of-the-art 3D CT report generation baselines, CLarGen mitigates Template Collapse and substantially improves clinical accuracy (macro-F1 0.487 vs. 0.189; CRG 0.472 vs. 0.368) while maintaining fluent reporting. Our results suggest that explicit, measurable clinical grounding is essential for template-collapse-resistant 3D CT report generation. Code will be released upon acceptance.

cs.CV↗

arXiv2026

Evo-MedAgent: Beyond One-Shot Diagnosis with Agents That Remember, Reflect, and Improve

Tool-augmented large language model (LLM) agents can orchestrate specialist classifiers, segmentation models, and visual question-answering modules to interpret chest X-rays. However, these agents still solve each case in isolation: they fail to accumulate experience across cases, correct recurrent reasoning mistakes, or adapt their tool-use behavior without expensive reinforcement learning. While a radiologist naturally improves with every case, current agents remain static. In this work, we propose Evo-MedAgent, a self-evolving memory module that equips a medical agent with the capacity for inter-case learning at test time. Our memory comprises three complementary stores: (1)~\emph{Retrospective Clinical Episodes} that retrieve problem-solving experiences from similar past cases, (2)~an \emph{Adaptive Procedural Heuristics} bank curating priority-tagged diagnostic rules that evolves via reflection, much like a physician refining their internal criteria, and (3)~a \emph{Tool Reliability Controller} that tracks per-tool trustworthiness. On ChestAgentBench, Evo-MedAgent raises multiple-choice question (MCQ) accuracy from 0.68 to 0.79 on GPT-5-mini, and from 0.76 to 0.87 on Gemini-3 Flash. With a strong base model, evolving memory improves performance more effectively than orchestrating external tools on qualitative diagnostic tasks. Because Evo-MedAgent requires no training, its per-case overhead is bounded by one additional retrieval pass and a single reflection call, making it deployable on top of any frozen model.

cs.AI↗

arXiv2026

Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning

MLLMs MLLMs are beginning to appear in clinical workflows, but their ability to perform complex medical reasoning remains unclear. We present Med-CMR, a fine-grained Medical Complex Multimodal Reasoning benchmark. Med-CMR distinguishes from existing counterparts by three core features: 1) Systematic capability decomposition, splitting medical multimodal reasoning into fine-grained visual understanding and multi-step reasoning to enable targeted evaluation; 2) Challenging task design, with visual understanding across three key dimensions (small-object detection, fine-detail discrimination, spatial understanding) and reasoning covering four clinically relevant scenarios (temporal prediction, causal reasoning, long-tail generalization, multi-source integration); 3) Broad, high-quality data coverage, comprising 20,653 Visual Question Answering (VQA) pairs spanning 11 organ systems and 12 imaging modalities, validated via a rigorous two-stage (human expert + model-assisted) review to ensure clinical authenticity. We evaluate 18 state-of-the-art MLLMs with Med-CMR, revealing GPT-5 as the top-performing commercial model: 57.81 accuracy on multiple-choice questions (MCQs) and a 48.70 open-ended score, outperforming Gemini 2.5 Pro (49.87 MCQ accuracy, 45.98 open-ended score) and leading open-source model Qwen3-VL-235B-A22B (49.34 MCQ accuracy, 42.62 open-ended score). However, specialized medical MLLMs do not reliably outperform strong general models, and long-tail generalization emerges as the dominant failure mode. Med-CMR thus provides a stress test for visual-reasoning integration and rare-case robustness in medical MLLMs, and a rigorous yardstick for future clinical systems.

cs.AI↗

arXiv2026

TimeFlow: Temporal Conditioning for Longitudinal Brain MRI Registration and Aging Analysis

Longitudinal brain analysis is essential for understanding healthy aging and identifying pathological deviations. Longitudinal registration of sequential brain MRI underpins such analyses. However, existing methods are limited by reliance on densely sampled time series, a trade-off between accuracy and temporal smoothness, and an inability to prospectively forecast future brain states. To overcome these challenges, we introduce \emph{TimeFlow}, a learning-based framework for longitudinal brain MRI registration. TimeFlow uses a U-Net backbone with temporal conditioning to model neuroanatomy as a continuous function of age. Given only two scans from an individual, TimeFlow estimates accurate and temporally coherent deformation fields, enabling non-linear extrapolation to predict future brain states. This is achieved by our proposed inter-/extra-polation consistency constraints applied to both the deformation fields and deformed images. Remarkably, these constraints preserve temporal consistency and continuity without requiring explicit smoothness regularizers or densely sampled sequential data. Extensive experiments demonstrate that TimeFlow outperforms state-of-the-art methods in terms of both future timepoint forecasting and registration accuracy. Moreover, TimeFlow supports novel biological brain aging analyses by differentiating neurodegenerative trajectories from normal aging without requiring segmentation, thereby eliminating the need for labor-intensive annotations and mitigating segmentation inconsistency. TimeFlow offers an accurate, data-efficient, and annotation-free framework for longitudinal analysis of brain aging and chronic diseases, capable of forecasting brain changes beyond the observed study period.

eess.IV↗

arXiv2026

Does DINOv3 Set a New Medical Vision Standard? Benchmarking 2D and 3D Classification, Segmentation, and Registration

The advent of large-scale vision foundation models, pre-trained on diverse natural images, has marked a paradigm shift in computer vision. However, how the frontier vision foundation models' efficacies transfer to specialised domains such as medical imaging remains an open question. This report investigates whether DINOv3, a state-of-the-art self-supervised vision transformer (ViT) pre-trained on natural images, can directly serve as a powerful, unified encoder for medical vision tasks without domain-specific fine-tuning. To answer this, we benchmark DINOv3 across common medical vision tasks, including 2D and 3D classification, segmentation, and registration on a wide range of medical imaging modalities. We systematically analyse its scalability by varying model sizes and input image resolutions. Our findings reveal that DINOv3 shows impressive performance and establishes a formidable new baseline. Remarkably, it can even outperform medical-specific foundation models like BiomedCLIP and CT-Net on several tasks, despite being trained solely on natural images. However, we identify clear limitations: The model's features degrade in scenarios requiring deep domain specialisation, such as in whole-slide images (WSIs), electron microscopy (EM), and positron emission tomography (PET). Furthermore, we observe that DINOv3 does not consistently follow the scaling law in the medical domain. Its performance does not reliably increase with larger models or finer feature resolutions, showing diverse scaling behaviours across tasks. Overall, our work establishes DINOv3 as a strong baseline, whose powerful visual features can serve as a robust prior for multiple medical tasks. This opens promising future directions, such as leveraging its features to enforce multiview consistency in 3D reconstruction.

cs.CV↗

arXiv2026

Learn2Reg 2024: New Benchmark Datasets Driving Progress on New Challenges

Medical image registration is critical for clinical applications, and fair benchmarking of different methods is essential for monitoring ongoing progress in the field. To date, the Learn2Reg 2020-2023 challenges have released several complementary datasets and established metrics for evaluations. Building on this foundation, the 2024 edition expands the challenge's scope to cover a wider range of registration scenarios, particularly in terms of modality diversity and task complexity, by introducing three new tasks, including large-scale multi-modal registration and unsupervised inter-subject brain registration, as well as the first microscopy-focused benchmark within Learn2Reg. The new datasets also inspired new method developments, including invertibility constraints, pyramid features, keypoints alignment and instance optimisation. Visit Learn2Reg at https://learn2reg.grand-challenge.org.

eess.IV↗

arXiv2025

Disentangling Progress in Medical Image Registration: Beyond Trend-Driven Architectures towards Domain-Specific Strategies

Medical image registration drives quantitative analysis across organs, modalities, and patient populations. Recent deep learning methods often combine low-level "trend-driven" computational blocks from computer vision, such as large-kernel CNNs, Transformers, and state-space models, with high-level registration-specific designs like motion pyramids, correlation layers, and iterative refinement. Yet, their relative contributions remain unclear and entangled. This raises a central question: should future advances in registration focus on importing generic architectural trends or on refining domain-specific design principles? Through a modular framework spanning brain, lung, cardiac, and abdominal registration, we systematically disentangle the influence of these two paradigms. Our evaluation reveals that low-level "trend-driven" computational blocks offer only marginal or inconsistent gains, while high-level registration-specific designs consistently deliver more accurate, smoother, and more robust deformations. These domain priors significantly elevate the performance of a standard U-Net baseline, far more than variants incorporating "trend-driven" blocks, achieving an average relative improvement of $\sim3\%$. All models and experiments are released within a transparent, modular benchmark that enables plug-and-play comparison for new architectures and registration tasks (https://github.com/BailiangJ/rethink-reg). This dynamic and extensible platform establishes a common ground for reproducible and fair evaluation, inviting the community to isolate genuine methodological contributions from domain priors. Our findings advocate a shift in research emphasis: from following architectural trends to embracing domain-specific design principles as the true drivers of progress in learning-based medical image registration.

eess.IV↗

arXiv2025

ReEvalMed: Rethinking Medical Report Evaluation by Aligning Metrics with Real-World Clinical Judgment

Automatically generated radiology reports often receive high scores from existing evaluation metrics but fail to earn clinicians' trust. This gap reveals fundamental flaws in how current metrics assess the quality of generated reports. We rethink the design and evaluation of these metrics and propose a clinically grounded Meta-Evaluation framework. We define clinically grounded criteria spanning clinical alignment and key metric capabilities, including discrimination, robustness, and monotonicity. Using a fine-grained dataset of ground truth and rewritten report pairs annotated with error types, clinical significance labels, and explanations, we systematically evaluate existing metrics and reveal their limitations in interpreting clinical semantics, such as failing to distinguish clinically significant errors, over-penalizing harmless variations, and lacking consistency across error severity levels. Our framework offers guidance for building more clinically reliable evaluation methods.

cs.CL↗

arXiv2025

Addressing Benchmarking Gaps in Large Language Models for Health and Medicine with Dynamic Red-Teaming

Large language models (LLMs) are increasingly used to answer health-related questions and support healthcare workflows, yet evidence for their safety still relies heavily on static benchmarks that can rapidly become obsolete or be optimized against. Here we introduce a Dynamic, Automatic, and Systematic (DAS) red-teaming audit framework that continuously stress-tests LLMs for health across four safety-critical axes: robustness, privacy, bias/fairness, and hallucination/factual inaccuracies. Validated against board-certified clinicians with high concordance, a suite of adversarial agents autonomously mutates health-related test cases to uncover vulnerabilities in real time. Applying DAS to 15 proprietary and open-source LLMs revealed a profound gap between high static benchmark performance and low dynamic reliability--the "Benchmarking Gap". Despite median MedQA accuracy exceeding 80\%, 94\% of previously correct answers failed under dynamic robustness testing. This brittleness generalized to the realistic, open-ended HealthBench dataset, where top-tier models exhibited failure rates exceeding 70\% and sharp shifts in model rankings across evaluations, suggesting that high scores on established static benchmarks may reflect superficial memorization. We observed similarly high failure rates across other domains: privacy leaks were elicited in 86\% of scenarios, cognitive-bias priming altered recommendations in 81\% of fairness tests, and hallucination rates exceeded 74\% in widely used models. By converting LLM safety evaluation for health from a static checklist into a living adversarial audit, DAS provides a scalable framework for surfacing latent risks before such systems are deployed in consumer-facing health assistants, clinician-facing tools, and broader healthcare workflows. Code is available at https://github.com/JZPeterPan/DAS-Medical-Red-Teaming-Agents.

cs.LG↗

arXiv2025

Beyond the LUMIR challenge: The pathway to foundational registration models

Medical image challenges have played a transformative role in advancing the field, catalyzing innovation and establishing new performance benchmarks. Image registration, a foundational task in neuroimaging, has similarly advanced through the Learn2Reg initiative. Building on this, we introduce the Large-scale Unsupervised Brain MRI Image Registration (LUMIR) challenge, a next-generation benchmark for unsupervised brain MRI registration. Previous challenges relied upon anatomical label maps, however LUMIR provides 4,014 unlabeled T1-weighted MRIs for training, encouraging biologically plausible deformation modeling through self-supervision. Evaluation includes 590 in-domain test subjects and extensive zero-shot tasks across disease populations, imaging protocols, and species. Deep learning methods consistently achieved state-of-the-art performance and produced anatomically plausible, diffeomorphic deformation fields. They outperformed several leading optimization-based methods and remained robust to most domain shifts. These findings highlight the growing maturity of deep learning in neuroimaging registration and its potential to serve as a foundation model for general-purpose medical image registration.

eess.IV↗

arXiv2024

Mamba? Catch The Hype Or Rethink What Really Helps for Image Registration

Our findings indicate that adopting "advanced" computational elements fails to significantly improve registration accuracy. Instead, well-established registration-specific designs offer fair improvements, enhancing results by a marginal 1.5\% over the baseline. Our findings emphasize the importance of rigorous, unbiased evaluation and contribution disentanglement of all low- and high-level registration components, rather than simply following the computer vision trends with "more advanced" computational blocks. We advocate for simpler yet effective solutions and novel evaluation metrics that go beyond conventional registration accuracy, warranting further research across diverse organs and modalities. The code is available at \url{https://github.com/BailiangJ/rethink-reg}.

cs.CV↗

arXiv2022

Learn2Reg: comprehensive multi-task medical image registration challenge, dataset and evaluation in the era of deep learning

Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multi-task medical image registration data set for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https://learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra- and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, as well as results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias. While no single approach worked best across all tasks, many methodological aspects could be identified that push the performance of medical image registration to new state-of-the-art performance. Furthermore, we demystified the common belief that conventional registration methods have to be much slower than deep-learning-based methods.

eess.IV↗

arXiv2022

Weakly-supervised Biomechanically-constrained CT/MRI Registration of the Spine

CT and MRI are two of the most informative modalities in spinal diagnostics and treatment planning. CT is useful when analysing bony structures, while MRI gives information about the soft tissue. Thus, fusing the information of both modalities can be very beneficial. Registration is the first step for this fusion. While the soft tissues around the vertebra are deformable, each vertebral body is constrained to move rigidly. We propose a weakly-supervised deep learning framework that preserves the rigidity and the volume of each vertebra while maximizing the accuracy of the registration. To achieve this goal, we introduce anatomy-aware losses for training the network. We specifically design these losses to depend only on the CT label maps since automatic vertebra segmentation in CT gives more accurate results contrary to MRI. We evaluate our method on an in-house dataset of 167 patients. Our results show that adding the anatomy-aware losses increases the plausibility of the inferred transformation while keeping the accuracy untouched.

eess.IV↗

arXiv2021

Patient-specific virtual spine straightening and vertebra inpainting: An automatic framework for osteoplasty planning

Symptomatic spinal vertebral compression fractures (VCFs) often require osteoplasty treatment. A cement-like material is injected into the bone to stabilize the fracture, restore the vertebral body height and alleviate pain. Leakage is a common complication and may occur due to too much cement being injected. In this work, we propose an automated patient-specific framework that can allow physicians to calculate an upper bound of cement for the injection and estimate the optimal outcome of osteoplasty. The framework uses the patient CT scan and the fractured vertebra label to build a virtual healthy spine using a high-level approach. Firstly, the fractured spine is segmented with a three-step Convolution Neural Network (CNN) architecture. Next, a per-vertebra rigid registration to a healthy spine atlas restores its curvature. Finally, a GAN-based inpainting approach replaces the fractured vertebra with an estimation of its original shape. Based on this outcome, we then estimate the maximum amount of bone cement for injection. We evaluate our framework by comparing the virtual vertebrae volumes of ten patients to their healthy equivalent and report an average error of 3.88$\pm$7.63\%. The presented pipeline offers a first approach to a personalized automatic high-level framework for planning osteoplasty procedures.

cs.LG↗